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Leading article 17
Hypnosis: a useful tool
in the medical care of
older people
S nce t e Br t s Denta an Me ca Soc ety accepte t e stu y of ypnos s nto ts curr cu um,ts usefu ness n treat ng an fac tat ng treatment as ecome firm y esta s e an s nowmp emente y psyc atr sts, psyc o og sts an many genera pract t oners. Dr Iain McIntosh
explores the benefits hynopsis can hold for phobic problems in the elderly and how its use canlimit the need for medication.
The ethical use of hypnotherapy in modern
medicine was accepted by the British
Medical Association in 1954. The British
Dental and Medical Society for the Study of
Hypnosis was established in 1955 and through
its courses many health professionals have been
introduced to hypnotherapy.
he use of hypnosis to treat and facilitate
treatment, or as an adjunct to therapy, is now
firmly established and utilised by psychiatrists,
psychologists and many general practitioners
(GPs). More recently, nurses and health visitors in
primary care have been acquiring and usingsimilar skills. Hypnotherapy is considered by
some to be a form of alternative medicine, but its
devotees consider it merely another tool for
curing and alleviating a patients psychological
and physical problems. The uses of hypnosis in
treatment include:
> pain and stress reduction;
> relieving asthma;
> curing insomnia;
> enhancement of performance and learning;
> behaviour modification altering habits and
addictions; and> overcoming phobias.
Hypnotherapy has gained respectability, with
several universities awarding a degree in the
subject and post-graduate medical education
courses on hypnotism are popular.
What is hypnosis?There is general agreement that hypnosis is an
altered conscious state involving mechanisms of
attention and behavioural habits. Attention is the
sine qua nonof hypnosis, differentiating it from
other altered conscious states. It facilitates rapid
learning, enhances memory and helps to condition
and alter behaviour more quickly than with an
unhypnotised patient
1
. The importance of hypnosisin treatment lies in its ability to bypass critical
faculties of the conscious mind.
What is hypnotic induction?Hypnotic induction is the process of preparing the
subject, facilitating the patient to loosen their
critical grasp on familiar reality and to accept
uncritically other evidence or suggestions. The
persons imagination is used to create the desired
state. There has been much literature written
about induction techniques, but the function ofthe induction procedure is merely to achieve this
state of acceptance. The means of its
accomplishment requires that the therapist be
july 2006/midlife and beyond/ geriatric medicine
DR
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eneral
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fortheStudyofHypnosis
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that would not have been threatening in their youth.
These behavioural responses can easily deteriorate
into panic and phobic states which, if unrecognised
and untreated, can become chronic and intractable.
Hypnosis can be used with simple cognitivebehavioural techniques to bring quick cure for mild
to moderate anxieties, panic states and simple
phobias (eg, fear of flying, animals, insects and
enclosed spaces) which can become disabling. These
anxiety states can often be easily reversed in one or
two short hypnotherapy sessions. All therapeutic
essions involve relaxation, stress reduction and
confidence building mechanisms that benefit those
crippled with anxiety and fear.
What is a phobia?A phobia exhibits a degree of anxiety and fear out
of all proportion to the situation. It cannot be
explained or reasoned away and is beyond
voluntary control. The person is subjectively afraid,
avoids the feared situation and, if exposed to it,
uffers tachycardia, hyperventilation and exhibits a
tate of anxiety or panic. This leads to avoidance
behaviour. Most patients respond well to simple
hypnotic techniques, which need not be time
consuming. Disturbed conditioned responses and
frantic avoidance behaviour can be quickly
replaced by rational activity with hypnotherapy.
Surveys2,3suggest the majority of phobics are
women and that travel-related fears represent 2.81
per cent of phobias . In my own general practice5
16 per cent of my patients admitted to having a
phobia and 13 per cent of this sub group reported
fear of flying. Elderly people were equally
represented in the survey.
Treatment by hypnosisHypnotherapy to treat phobias involves behaviourmodification and desensitisation techniques. The
therapy is facilitated by trance state induction. The
patient is exposed to the situation in their
imagination which causes distress until he/she
ets used to it and attempts are then made to
extinguish the fear by relating it to a pattern of
response that provokes no anxiety. Common
induction techniques are eye fixation, progressive
relaxation, arm levitation and cognitive imagery.
Desensitisation7
consists of muscle relaxation,reduction of anxiety and construction of a graded
hierarchy of aversive stimuli. For example, a
hierarchy for a flying phobia could involve:
Leading article18
eriatric medicine/midlife and beyond/ july 200
killful but which technique is actually used is not
of primary consideration. In many people
induction can be achieved very quickly and time
is a major consideration for those using hypnosis
in the primary or institutional care setting.
Much research has been committed to the
psychological elements of hypnotic states with
controversial findings but a deep understanding
of exactly how the process actually works is not
needed to use it to cure and help patients. Many
professionals consider hypnosis and induction as
mere therapeutic tools and employ them as they do
a computer as a work aid. And like a computer
their understanding of the inner workings of the
machine are limited, but they know the
mechanism does work and that its outcome isatisfactory. Initial apprehension about the
hazards of hypnotherapy in clinical use has not
been justified.
Who can benefit fromhypnotherapy?Almost anyone can benefit from hypnotherapy.
Children are particularly responsive to hypnosis
and are ideal subjects for the novice practitioner.
Concern over the attention spans of elderly people
as well as their concentration skills have
dissuaded some hypnotherapists from using the
therapy on them. But the majority of older people
can be hypnotised successfully. The depressed,
those with dementia and those with long-term
chronic problems should not be considered, but
many others can benefit from hypnosis in primary
and adjunctive treatment, often avoiding the use of
drugs in removing unwanted psychological
ymptoms and relieving aches and pains.
Professional time is a concern in clinical
management since GPs and hospital practitioners
undertake procedures that involve brief patient
encounters. With carefully selected older patients
affected by clearly defined conditions, the use of
hypnosis is practical and can effectively influence
their physical and physiological status. It can
prevent an acute case from becoming chronic while
enhancing general well being. Dependence upon
anxiolytics and analgesics can be avoided by
recourse to the hypnotherapeutic tool.
Elderly people often admit to loss of selfconfidence as their faculties and powers appear to
fade. These apparent failings and mild memory
impairment are stressful, fanning fear in situations
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Leading article
> arrival at the airport;
> proceeding to the departure lounge;
> walking on to the plane;
> experiencing take-off;
> landing.
The hierarchy is presented in imagery in
hypnotherapy. Desensitisation with hypnosis
can be achieved in one or two patient
encounters and with minimal therapist contact.
Use can be made of tape recordings and book
instruction on relaxation and desensitisation
procedures. Modified flooding techniques of
psychotherapy can also be used when time
constraints prevail where, instead of gradual
desensitisation by states, the patient is subjected
to intensive exposure to the feared objects oftate while relaxed in a trance.
Teaching the patient autohypnosis, whereby
at a coded signal he/she can recreate the relaxed
tate acquired at earlier sessions, decreases the
risk of dependence on a therapist and
diminishes the time required for therapy.
ScenarioTo demonstrate the technique, let us take the
example of an elderly lady with grown children
living in the Far East. Unfortunately, she had
long had a phobia for air travel and could not
visit them. Widowed and lonely and worried
about her offspring the children bought her air
tickets for Australia one Christmas. With great
doubt and concern, she accepted the gift but as
the flight approached she became ever more
anxious and fearful. The day before departure she
uccumbed to panic at the thought of many hours
incarcerated in an aircraft.
Presenting at her doctors surgery, she was
very agitated and wanted to cancel the flights,
but accepted an offer of hypnotherapy. She
relaxed visibly under hypnosis and was
uided into a visual image of herself boarding
and sitting in the aeroplane. With continued
uggestions of calmness, muscle and mind
relaxation, and freedom from tension, she was
able to fantasise herself through prolonged
exposure to the feared situation. Given post
hypnotic suggestions about calmness throughout
the flights, to her and the familys delight, shemade a successful journey. Five years and many
air trips later she remains undisturbed by the
once disabling phobia.
Gentle words, quiet words are, after all, the
most powerful words. They are more convincing,more compelling, more prevailing and very
successful.
These were lines a patient quoted after hypnotic
treatment for an anxiety state. The same general
principles of hypnotherapy apply to the treatment of
imple anxiety states and panic attacks . Careful
election of patients, strict adhesion to short-term
treatment, as well as the use of instruction leaflets
and taped procedures, can make for successful and
clinically rewarding interventions.
Hypnosis can prove a valuable therapeutic
weapon used as an adjunct or an alternative to
conventional patient care. GPs should acquire
appropriate skills at educational courses offered by
ocieties and universities to use in their day-
to-day practice.
Conflict of interest: none declared.
. Erickson MH 1980. The Natureof hypnosis and suggestion EdRossi EL. New York Irvington
. Agras S, Sylvester, and OliveauD. The epidemiology ofcommon fears and phobias.Comprehensive Psychiatry1969; 10: 2, 151
. Burns L, Thorpe G. Fears andphobias.Journal of I nternational
Medical Resea rch 977. 5:Suppl 1: 132-139
4. McIntosh I. Pain relief and thepower of suggestion.Journal ofthe British Society of Mental
Hypnosis 1999.XIX: 25-29. McIntosh I. Incidence,
anagement and treatment ofphobias in a group medicalpractice. harmaceutical
Medicine 1980. 2: 77-826. McIntosh I. Hypnotherapy: The
ase for the GP. sychiatry inractice, November 1981. 10:4-17
. France R, Robson M. 1986.Behaviour therapy in primaryare 66. Croom Helm
Publishers8. Rostrum Compendium of
ypnotherapy. 2001 EdMcIntosh IB Brit.Socy Med.Dental Hypnossis./ Scotland.Monument Press Stirling
References
> Hypnosis is an altered conscious state
involving mechanisms of attention and
behavioural habits.
> Hypnosis facilitates rapid learning, enhancesmemory and helps to condition and alter
behaviour quickly
> Hypnotic techniques can be useful in treating
panic states and phobias in the elderly.
> Hynotherapy should not be used on patientssuffering from dementia or those having
long-term chronic illness.
Key points
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